刺激诱发性职业性哮喘的临床特点
2022/03/17
摘要
背景：工作是成年起病的哮喘的重要促成因素。职业性哮喘（OA）的一个亚型是由刺激性物质引起的，但对刺激诱发性哮喘（IIA）的临床特点的了解尚不完整。
目的：评估IIA的临床表现是否与致敏剂诱导的OA不同。
方法：这项回顾性研究分析了2004-2018年间在职业医学诊所确诊的急性和亚急性IIA患者。69名患者符合纳入标准，并在诊断时和6个月后分析其特征。结果与两组致敏剂诱导的OA，即69名高分子量（HMW）和89名低分子量（LMW）药物诱导的OA患者的结果进行了比较。
结果：确诊6个月后，30%的IIA患者需要每日服用短效β-受体激动剂（SABA），68%的患者接受了GINA 4-5级药物治疗，24%的患者在首次就诊后有哮喘发作。IIA描述了在SABA（OR 3.80，95%可信区间1.38-10.46）、GINA 4-5步药物治疗（OR 2.22，95%可信区间1.08-4.57）和疾病发作（OR 3.85，95%可信区间1.35-11.04）的日常需求方面，低于LMW诱导的OA。在后两个特征中，IIA的结果比HMW诱导的OA差（OR分别为2.49,95%可信区间1.07-5.79和OR 6.29,95%可信区间1.53-25.83）。
结论：职业性哮喘诊断六个月后，很大一部分IIA患者仍有症状，大多数患者广泛使用哮喘药物，表明哮喘未得到控制。IIA的短期疗效似乎比敏化剂诱导的OA差。
Clinical characteristics of irritant-induced occupational asthma
Jussi Lantto, Hille Suojalehto, Kirsi Karvala, Jouko Remes, Satu Soini, Katri Suuronen, Irmeli Lindström
Abstract
Background: Work is a substantial contributing factor of adult-onset asthma. A subtype of occupational asthma (OA) is caused by irritant agents, but knowledge of the clinical outcomes of irritant-induced asthma (IIA) is incomplete.
Objectives: To evaluate whether the clinical picture of IIA differs from that of sensitizer-induced OA.
Methods: This retrospective study analyzed acute and subacute IIA patients diagnosed in an occupational medicine clinic during 2004-2018. Sixty-nine patients fulfilled the inclusion criteria, and their characteristics were analyzed at the time of the diagnosis and six months later. The results were compared to those of two subgroups of sensitizer-induced OA, 69 high-molecular-weight (HMW) and 89 low-molecular-weight (LMW) agent -induced OA patients.
Results: Six months after the diagnosis, 30% of the IIA patients needed daily short-acting beta agonists (SABA), 68% were treated with GINA step 4-5 medication, and 24% of the patients had asthma exacerbation after the first appointment. IIA depicted inferiority to LMW-induced OA in daily need for SABA (OR 3.80, 95% CI 1.38-10.46), treatment with GINA step 4-5 medication (OR 2.22, 95% CI 1.08-4.57) and exacerbation (OR 3.85, 95% CI 1.35-11.04). IIA showed poorer results than HMW-induced OA in the latter two of these features (OR 2.49, 95% CI 1.07-5.79 and OR 6.29, 95% CI 1.53-25.83 respectively).
Conclusions: Six months after the occupational asthma diagnosis, a significant proportion of the IIA patients remain symptomatic and the majority of these patients use asthma medications extensively suggesting uncontrolled asthma. The short-term outcomes of IIA appear poorer than that of sensitizer-induced OA.
背景：工作是成年起病的哮喘的重要促成因素。职业性哮喘（OA）的一个亚型是由刺激性物质引起的，但对刺激诱发性哮喘（IIA）的临床特点的了解尚不完整。
目的：评估IIA的临床表现是否与致敏剂诱导的OA不同。
方法：这项回顾性研究分析了2004-2018年间在职业医学诊所确诊的急性和亚急性IIA患者。69名患者符合纳入标准，并在诊断时和6个月后分析其特征。结果与两组致敏剂诱导的OA，即69名高分子量（HMW）和89名低分子量（LMW）药物诱导的OA患者的结果进行了比较。
结果：确诊6个月后，30%的IIA患者需要每日服用短效β-受体激动剂（SABA），68%的患者接受了GINA 4-5级药物治疗，24%的患者在首次就诊后有哮喘发作。IIA描述了在SABA（OR 3.80，95%可信区间1.38-10.46）、GINA 4-5步药物治疗（OR 2.22，95%可信区间1.08-4.57）和疾病发作（OR 3.85，95%可信区间1.35-11.04）的日常需求方面，低于LMW诱导的OA。在后两个特征中，IIA的结果比HMW诱导的OA差（OR分别为2.49,95%可信区间1.07-5.79和OR 6.29,95%可信区间1.53-25.83）。
结论：职业性哮喘诊断六个月后，很大一部分IIA患者仍有症状，大多数患者广泛使用哮喘药物，表明哮喘未得到控制。IIA的短期疗效似乎比敏化剂诱导的OA差。
(中日友好医院呼吸与危重症医学科 顾宪民 摘译 林江涛 审校 )
(J Allergy Clin Immunol Pract. 2022 Mar 5;S2213-2198(22)00222-7. doi: 10.1016/j.jaip.2022.02.021.)
(J Allergy Clin Immunol Pract. 2022 Mar 5;S2213-2198(22)00222-7. doi: 10.1016/j.jaip.2022.02.021.)
Clinical characteristics of irritant-induced occupational asthma
Jussi Lantto, Hille Suojalehto, Kirsi Karvala, Jouko Remes, Satu Soini, Katri Suuronen, Irmeli Lindström
Abstract
Background: Work is a substantial contributing factor of adult-onset asthma. A subtype of occupational asthma (OA) is caused by irritant agents, but knowledge of the clinical outcomes of irritant-induced asthma (IIA) is incomplete.
Objectives: To evaluate whether the clinical picture of IIA differs from that of sensitizer-induced OA.
Methods: This retrospective study analyzed acute and subacute IIA patients diagnosed in an occupational medicine clinic during 2004-2018. Sixty-nine patients fulfilled the inclusion criteria, and their characteristics were analyzed at the time of the diagnosis and six months later. The results were compared to those of two subgroups of sensitizer-induced OA, 69 high-molecular-weight (HMW) and 89 low-molecular-weight (LMW) agent -induced OA patients.
Results: Six months after the diagnosis, 30% of the IIA patients needed daily short-acting beta agonists (SABA), 68% were treated with GINA step 4-5 medication, and 24% of the patients had asthma exacerbation after the first appointment. IIA depicted inferiority to LMW-induced OA in daily need for SABA (OR 3.80, 95% CI 1.38-10.46), treatment with GINA step 4-5 medication (OR 2.22, 95% CI 1.08-4.57) and exacerbation (OR 3.85, 95% CI 1.35-11.04). IIA showed poorer results than HMW-induced OA in the latter two of these features (OR 2.49, 95% CI 1.07-5.79 and OR 6.29, 95% CI 1.53-25.83 respectively).
Conclusions: Six months after the occupational asthma diagnosis, a significant proportion of the IIA patients remain symptomatic and the majority of these patients use asthma medications extensively suggesting uncontrolled asthma. The short-term outcomes of IIA appear poorer than that of sensitizer-induced OA.
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痰炎症表型对哮喘小气道功能障碍和疾病转归的纵向影响
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血清IgE浓度预测重度嗜酸性粒细胞哮喘患者恶化风险的能力和Benralizumab疗效
